TransMed
One Stage MTF GRS:
The Value of this Genital Reconstruction Surgical Procedure
in the Male to Female Transsexual |
By Sheila Kirk, M.D and J. William Futrell, MD |
In the past a one-stage MTF genital reconstruction surgery known also as SRS was a commonplace surgical procedure, particularly in the hands of European surgeons. In recent years however, the operation has most often been performed in 2 stages. The first stage is for removal of the penis and the testes and then the creation of the clitoris and vagina. The second stage is reserved for the cosmetic or aesthetic effect to create as close to the appearance of a genetic woman's external genitalia as possible.
In questioning patients directly and with surveys returned by over 600 MTF post-op individuals whose surgeries were performed by various surgeons using the two-stage method, it has become very clear that slightly over 40% of patients do not seek the second stage as now done to improve the cosmetic appearance of their genitalia.1 There is in addition, no doubt, many who decide to be re-operated who also have some corrective procedures done, i.e. changes in the urethral direction or clitoral surgery, on top of the cosmetic work. Those requesting surgical correction may be as many as 20%, according to some reports. With that in mind one wonders what percentage of this latter group would seek the cosmetic surgery if a corrective need was not present?
The surgeons of TSMC favor the one stage procedure in Vaginoplasty or GRS for a number of reasons. Foremost is the fact that we recognize the significance of the 40% statistic quoted in this article. If such a large number rely on the first stage as sufficient then shouldn't they deserve to have results that achieve for them the most realistic appearance, function and sensation as is possible? The one-stage procedure that we at TSMC have perfected goes a considerably longer distance than the Stage 1 of a 2-stage operation. It creates labia majora (external vaginal lips)
that are united at the upper aspect of the new vulva and united so as to hood the newly created clitoris. This is extremely authentic in appearance, notably like that of the genetic female, and distinctly different from labia that point in opposite directions as seen in post-ops who have had only the 1st stage of the two-stage GRS procedure.
For that 4 out of 10 not choosing to have the second operation, this one stage procedure offers a much better result than what is currently being created for them in the 1st of a two-stage procedure. TSMC's procedure goes a long way toward creating female genitalia with a realistic appearance without the extra cost of the two-stage operation, additional time loss and travel expense that is required to return for the second stage. These reasons alone are often a consideration for many since the Stage Two procedure averages about $3,000. (all fees included) and for many that can be distinctly a difficult price to pay.
Some inaccurately believe, that two-stage procedures are more favorable because of fears of poor healing when the proper positioning of the labia majora is included in a one-stage procedure. Good healing relies almost totally upon good blood supply. There is no doubt that to compromise the amount of blood available to an operated area is to threaten the result greatly. In the one stage operation performed by us, blood supply is not at risk. Labial construction and union can be accomplished because of a special technique we utilize. The blood supply is very much preserved and adequate because we use a de-epithializaton technique in the superior or upper portion of the operation to move tissues and consequently do not interfere with dermal and subdermal blood flow. The vessels in the dermis
and tissues below retain good vascularizaiton, which insures good nutrition and oxygenation to the areas involved. The labia are joined appropriately and also hood the clitoris as in genetic women. This technique is soon to be reported by the lead writer of this article, J. William Futrell, MD, in the prestigious Plastic and Reconstructive Surgery Journal.
TSMC's one stage GRS operation not only achieves realistic appearance but also goes a long way to assure functionality and the potential for proper organ sensation so necessary for satisfying sexual activity. Our refined
technique contributes to the success of all three of these desirable results because nerve supply is not as impaired as it is with deeper surgery that is often employed with other procedures.
Ernest K. Manders, M.D.
Sheila Kirk, M.D.
Drs. Kirk and Futrell are two of three principal surgeons performing
Genital Reassignment Surgery and related Trans surgeries at the first
Transgender Surgical & Medical Center (TSMC) developed and directed by a
Trans surgeon. You can receive more information about the TSMC Center
located in Pittsburgh, PA or ask Dr. Kirk questions on your treatment and
care, by contacting her at TSMC@aol.com, by phone (412) 781-1092, fax
(412) 781-1096 or snail mail: TSMC P.O. Box 38366, Blawnox, PA 15238.
1: From a post-operative Male to Female Survey - a longitudinal study - conducted by Sheila Kirk, M.D.. Preliminary reporting on sexual experience in 100 respondents made to the Harry Benjamin International Gender Dysphoria Association meeting in Vancouver, BC Canada, September 1997.
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